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CITY OF DIAMOND BAR
-----��` -- DEPARTMENT QF COrRvIUNTI'I'&DEVELOPMENT SERVICES
Q_ 21825 E.Copley Drive '
(909)860-3195 Fax(909)861-3117 PRESS
''-���' BUILDING PERMIT APPLICATION FIRMLY
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p I HEREBY AFFIRM UNDER PENALTY OF PERIURV THAT I AM EXEMPT FHOM THE CON7RACTORS LI� G8f8(J6/C9fpOR �
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TURE,PRIOR TO ITS ISSUANCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PERMI7 70 FILE A SIGNED
w STATEMENT THAT HE OR SHE IS LICENSEO PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- w
� CENSE UW(CHAPTER e(COMMENCING WITH SECTION 7000)OF DIVISION 3OF THE BUSINESS AND PRO- � POOVSp2
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� TION.ANV VIOLATION OF SECTION 7031.5 BY ANV APPIICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof
A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(SSOo).):
Z ❑I,ASONRJEROF7HEPROPER7Y,ORMYEMPLOVEESWI7HWAGESASTHEIRSOLECAMPENSA710N, 0 COrtIrtIBfClel –
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEFiED FOR SALE(SEC.701a,BUSI- J
� NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF �
PROPERTV WHO BUILDS OR IMPROVES THEFiEON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
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� � 70 CONSTRUC7 THE PRQIECT(SEC.7oa4,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS Lb V81UffiIOl1 ADJ.AREA
W CENSE UW DOES NOTAPPLY TO AN ONMER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND
� WHOCANTpACTSFORSUCHPRQIECTSWI7HACON7RAC70R(S)LICENSEDPURSUANTTOTHECANTRAG QUANTITY DESCRIPTION FEE
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� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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DATE OWNER �
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� LICENSED CONTRACTORS DECLARATION w
� I HEREBY AFFIRM UNDER PENALTY OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTEfl �r
� 9(COMMENCING WITH SECTION 7000)OF OIVISION 30F THE BUSINESS AND PROFESSIONS CODE,AND Z
`X MY LICENSE IS IN FULL FORCE AND EFFEC7. m
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V DATE � CONTRACTOR - n- -
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� ORKERS'COMPENSATION DECLARATI Q e� ��� ` ����
� I HEREBVAFFIRM UNDER PENALTV OF FERJURV ONE OF THE FOLLOWING DECLARATIONS: Z
�� Z ✓ IMAVEANDWILLMAINTAINACERTIFICATEOFCANSENTTOSELF-INSUPEFORWORKEHS' _ �
¢ CAMPENSA710N,AS PROVIDED BY SECTION 370o OF THE LABOR CADE,FOR THE PERFORMANCE w
OF THE WORK FOR WHICH THIS PERMI7151SSUED. �
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w _I HAVE AND WILL MAINTAIN WORKEHS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q 370o OF THE LABOR CADE,FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS
ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBEHARE: CONSTRUCTION
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� (IHISSECTIONNE�NOTBENMREfEDOFTHEPERMfTISFORONEHUPDREDDOLLARS(5100)ORLESS). PLUMBING
Z I CEHTIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL p�
(.'} SHALL NOT EMPLOV ANY PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE
(/) WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE _
= SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION300OFTHELABOR
CODE.ISHALLFORTHWITHCOMPLVWITHTHOSEPRO S S. ISSUANCE �J •
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p DATE:_��r���P� APPLICANT: .
J WFRNING: AILU TO SECURE WORKERS' PENSA710N COV IS UNLAWFUL,AND SHALLBE ENERGY P/C
� SU&IECTANE LOYERTOCRIMINALPENALTIESANDCIVILFI 700NEHUNDHEDTHOUSAND ENERGYPERMIT
DOLURS(S7oo.o00�.IN ADDITION TO THE COS70F CAMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION 3708 OF THE LABOR CADE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE:
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� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEFiEBV AFFIRM UNDER PENALTY OF PERJURY THATTHEfiE IS ACONSTRUCTION LENDING ACaENCY
n- FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.).
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� LENDER'S NAME
F— LENDER'SADDRESS
� TOTAL FEES
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
w 1 AGREE TO COMPLV WITH ALL CITY AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING '
� CONSTRUC710N,AND HEREBV AU7HORIZE REPRESENTA7IVES OF 7HIS COUNTV TO ENTER UPON THE
� ABOVE-MENTIONED PROPEFiTY FOR INSPEC710N PURPOSES.
Z , COMMENTS
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� SIGN REOFPERMITT DATE �
= RECPT.��0. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENR D—File Copy,GREEN—Applicant's Copy
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SET BACK ' I FLOOR JOIST ;
FTGS/FORMS/STEEL ! ' FHA REG�MTS j
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ELEGTRIC GROUN� ' � ; UND�R FLt�C?R DUCI" ;
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GROUND PLUMBING i UNDER FLOOR CUI�IDUIT j ;
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I FIRERLACE FdUNDATION
SLAQ GRADE '
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TEiv9P POWER i i. FIREPLAC� BOND BEAM -
WATER SERVICE —T- ' MID HT. BOND BEAM
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ROOF SHEATHING_.____ --- -.-- -- ----8 FT. BOND BEAM � --------------I
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FRAMINGNENTILIATION � FINAL BOND BEAM __.,_
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ROOF COVER � PRE-GRA�WG i
ROUGH HE,4TING BERlCHING I
ROUGH ELEGTRIC � ( ROU�H GRADING � ����
ROUGH PLUNIBING � � ; FINISH GRADING
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SHOWER/TUB TEST '; POOL ELECTRIC
_ —�- ---- --____ _____-- --.____�---
EXT. l�4TH/SIDING ' , POOL FENCING
WALL INSULATIOIV POOL FINAL
CEILING IIV�ULATION OFF SITE IMPS. �
_ —_ --- --- ----- ------------ --
DRYWALL NAILIiJG DEDICATIONS ;
SEWER FINAL ENG. � �
SEPTIC TANK LAI�DSCAPEIIRRIG. �
SEEP PIT/LL. � ON 51TE IMPS. ��
GAS AIR TEST FINAL ZONING •
FINAL CONST. �IRE DEPT. FINAL
FINAL HEATING - HEALTH DEPT. FINAL v
FINAL ELECTRIC � DEV. FEES PAlD
FINAL PLUMBItJG ENERGY
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